Provider Demographics
NPI:1982871331
Name:CAMPOS, SHELLIE SMITH (NP)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:SMITH
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 EAST ST
Mailing Address - Street 2:JOHN MUIR HEALTH BREAST HEALTH CENTER
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1906
Mailing Address - Country:US
Mailing Address - Phone:925-674-2001
Mailing Address - Fax:925-674-2209
Practice Address - Street 1:133 LA CASA VIA STE 140
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3005
Practice Address - Country:US
Practice Address - Phone:925-947-3322
Practice Address - Fax:925-947-3394
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 525510, NP 8676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP8676OtherNURSE PRACTITIONER